Further, a woman's breasts naturally prepare for the arrival of her newborn by darkening and enlarging the areola, thus making the breast more obvious and visually appealing to a new baby. All breastmilk begins as yellow-colored, nutritionally dense colostrum. It soon changes to transitional milk, and then to mature milk. These biological events occur for all healthy, lactating women. No matter where one resides in the world, the biology of a woman being able to lactate and feed her child doesn't differ, and hasn't since the first mother nursed her child.
As the biology of breastmilk is essentially the same for all females in the human species, it stands to reason that breastfeeding is the same around the world. However, this could not be further from the truth. Cultural influences significantly impact breastfeeding practices around the globe. In fact, breastfeeding varies not only from culture to culture, but from woman to woman, even those who exist inside the same cultures.
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In celebration of the many ways that women (and some men!) feed their children, we're taking a closer look at the various cultural norms that shape breastfeeding around the world. From traditions to law, we honor the differences that shape the way women nurture and feed their children.
This brief glimpse into breastfeeding within various cultures of the world helps to show how cultural norms, societal beliefs, education, law, and religion all shape the way a woman breastfeeds. It is by no means exhaustive; as we said, in many cultures and regions, the views and perspectives of breastfeeding differ greatly, and even to this day, we see much diversity and dichotomy in the art and science of breastfeeding.
While the breastfeeding values and norms listed below indicate how some cultures feed their babies, it's important to remember that breastfeeding traditions vary considerably, even within the same country or geographical area. For so many of us, the privilege of living in a place where our options are not too limited, our freedoms are somewhat protected and our womanhood and motherhood is even celebrated, if only within the bonds of sisterhood we share, it's easy to look at another's cultural norms and mores and draw conclusions based on assumption. That is not our intent in this traditional outline; we simply want to celebrate motherhood and breastfeeding with women worldwide.
A landlocked country in east-central Africa, Rwanda has been steadily rebuilding its infrastructure since the 1994 genocide when an estimated one million lives were lost. As a result of the genocide, many women no longer have older female relatives, such as mothers and aunts, who historically would help support and educate new mothers.
Rwandan women are beginning to receive the message that breastfeeding is best from government and health officials, such as those recently issued about the importance of exclusive breastfeeding from the Rwanda Ministry of Health.
Rwanda has relatively high rates of breastfeeding compared to other African countries with approximately 87% of women exclusively breastfeeding for six months. However, economic and cultural factors reduce the number of women who successfully breastfeed.
According to Maryjo Kelly-Terrill MSW, RN, an experienced midwife who is currently working with mothers in Rwanda, says there are many myths surrounding breastfeeding. For example, some Rwandan grandmothers believe that a woman does not have milk for the first three days of life. As they are not educated about colostrum, and the importance of supply and demand, some grandmothers bring formula to infants immediately after birth.
Further, despite being a tropical country, most parents bundle their newborns in thick layers of clothing, making the infants extremely hot. The over-dressing of babies also prevents the important skin-to-skin contact that enhances milk flow from mother to child. While the protection of the baby's skin is important for many reasons (striking sun and pests), more advocates are working to encourage mothers to let nature be more open and engaging in skin-to-skin more. This encourages a mother to naturally want to nurse, and can help break the old-wives myths.
Rwanda Photo Credit: Maryjo Kelly-Terrill, MSW, RN
The southwestern country of Namibia, with a population of 2.5 million people, has relatively low breastfeeding rates. In fact, at six months of age, only 24% of mothers continue to breastfeed exclusively. The low breastfeeding rates present a significant public health issue according to UNICEF. One in four children under the age of five in Namibia is stunted, and one in seven is underweight. Heartbreaking when we know not only the importance of nursing, but how easily breastfeeding could tear down those statistics in a mighty way.
Despite these grim statistics, one Namibian tribe has shown great success surrounding breastfeeding. With an estimated population of approximately 50,000 people, the ancient Himba tribe of northwest Namibia have close to 100% exclusive breastfeeding rates. With no hospital within reach, these semi-nomadic women give birth at home, and each one breastfeeds. They give in to their natural instinct out of need, but also ability.
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While breastfeeding is such a natural part of the Himba culture, one might think breastfeeding comes easily to the Himba woman. After all, public breastfeeding is simply a way of life for the tribe. However, according to reporter Michaeleen Doucleff, this is not the case. In a recent NPR article, Doucleff highlights some of the reasons for successful breastfeeding within the Himba tribe.
While many of the Himba women face the same breastfeeding challenges that women in developed countries face, such as low supply, latch issues, or lack of confidence, anthropologist Brooke Scelza says that the Himba women have something that many women don't: guidance and support. Towards the end of their pregnancies, the women move in with their mothers, who nurture them and guide them through their breastfeeding journey, even waking them to feed their babies.
According to Scelza, the low rates of breastfeeding throughout the world have less to do with the loss of instinct and more to do with the lack of cultural guidance from women who came before us. As we continue to educate as we can, those numbers can only rise.
Despite being relatively wealthy and educated, the UK holds the record for being worst developed when it comes to breastfeeding. A 2016 Lancet report reveals just how dire the situation is. According to the study, only 0.5 percent of women continue to breastfeed their babies in Britain at one year of age. In comparison, approximately 30% of American women continue to breastfeed until a child reaches their first birthday. According to data from 2017-2018, the rates are only going down, despite research and recommendations that more mothers nurse and continue nursing.
One of the lead authors of the 2016 study suggests that there is a misconception among British women that breastfeeding is primarily beneficial for those living in poorer countries. Others suggest that the aggressive marketing of infant formula is partially to blame. Both of these reasonings sound very similar to the thinking of US mothers in the 70s, as nursing was touted as the only option 'poor' mothers who could not afford formula had, or a way to 'tie women down' and prevent them from working outside of the home during the time fighting for equal rights was big.
According to researchers at Cardiff University in the UK, low breastfeeding rates in the UK can also be attributed to lack of peer support. The study revealed that only half of new moms have access to breastfeeding support, and that there are contradictory messages around breastfeeding throughout the UK. Generally speaking, British women are encouraged to get their babies on a schedule and to return to work, with the goal of returning to their pre-baby lives soon after giving birth. Motherhood is seen as something done, but not breastfeeding, which is seen as 'yukky' and women's bodies are seen as an uncomfortable topic.
As with any large country, there is a wide variation of breastfeeding practices throughout China. According to UNICEF, the breastfeeding rates in China are meager and continue to decline. Until the 1970s, breastfeeding was the norm within the country. However, the abysmal breastfeeding rates can be attributed to the aggressive marketing of formula within the nation that began at that time. China now has the largest market of breast-milk substitutes in the world. Formula feeding has become ingrained in much of the Chinese culture.
However, there is a practice in China that is very conducive to breastfeeding. Some Chinese mothers follow the postpartum tradition of "sitting the month," also referred to as 'the confinement month' or Zuo Yue Zi. This practice, which is deeply rooted in Chinese culture, requires that a new mother not leave her house for 30 days after giving birth. While many rules surround this sacred time, the basic premise is that a woman recovers and bonds with her baby.
For many women who honor the Zuo Yue Zi, breastfeeding is sometimes more successful. Frequently, the new mother is supported by other caretakers, leaving her time and energy to breastfeed. The new mother is typically served lactation-stimulating soups or fish to help enhance milk production. However, as a mother is encouraged to minimize holding her baby during this first month and only breastfeed lying down, this can be counter-productive to oxytocin release. Earth Mama Organics launched a 'Lying In' campaign to encourage this type of tradition in other parts of the country too, with the same premise of making a conducive environment for mothers to nurse a given.
Kenya is a prime example of a country that has significantly improved its breastfeeding rates. This African country of over 46 million has implemented two government initiatives that have helped to increase exclusive breastfeeding rates at six months of age from 13% to 61% in a little over ten years.
While breastfeeding support abounds in much of Kenya, the attitudes surrounding breastfeeding vary depending on geographical location and cultural background. Existing myths and wives tales cause some women to terminate breastfeeding early or to avoid breastfeeding altogether.
For example, some Kenyan women, particularly among the Sukuma, believe that colostrum is dirty. As such, they express this essential nutrient-dense milk and dispose of it instead of giving it to their children. According to one Sukuma village elder, "Even if the mother doesn't have fingers she would rather ask for assistance to express colostrum for the first 2 days and throw it away." As education grows and spreads, this myth is slowly, but surely being debunked.
Women of the Luo and Luhya ethnic tribes believe that arguments with neighbors or family members can cause breastmilk to become unsafe for the baby. As such, if a disagreement occurs, a woman must undergo 'manyasi,' a cultural cleansing ritual, before she resumes breastfeeding. If the herbal cleansing ritual does not occur, the woman will discontinue breastfeeding.
While some Kenyan women breastfeed in public, others avoid doing so for fear of community members with an "evil eye." It is perceived that if those with an evil eye witness a woman breastfeeding, she is at risk for having her milk might dry up or for developing breast sores.
As breastfeeding becomes more widely accepted in Kenya, some women are fighting back. A recent incident in the city of Nairobi illustrates just how far the country has come regarding breastfeeding acceptance. When a woman was told to stop breastfeeding her one-year-old child in a restaurant, hundreds of women rallied in support of the mother, causing the restaurant owner to issue a public apology. Incidents of support like this are critical to encouraging other mothers.
Mongolian babies are fortunate to be born in a country that celebrates breastfeeding. Located in Asia, Mongolia leads the way of developing nations when it comes to breastfeeding initiation, exclusive breastfeeding at six months, and extended breastfeeding into toddlerhood. In fact, it's not unusual for mothers to breastfeed their children well into their preschool years or beyond.
Ruth Kamnitzer writes of her experience living and raising her son in Mongolia. In her account, she praises the Mongolian attitude surrounding breastfeeding. While breastfeeding in public, strangers would applaud her efforts. From grandmothers congratulating her in the park to taxi drivers giving her the 'thumbs up' sign as she nursed in the back seat of a cab, the support was abundant.
She recalls, "Instead of looking away, people would lean right in and kiss Calum on the cheek. If he popped off in response to the attention and left my streaming breast completely exposed, not a beat was missed. No one stared, no one looked away - they just laughed and wiped the milk off their noses."
Breastmilk is universally loved in Mongolia. In fact, valued for its nutritional value, it is often given freely to friends and family. Most Mongolians will tell you that they enjoy the taste as well. While some women leave a cup of breastmilk for their partners, others must hide it for fear of it being taken from the office fridge. It is shared freely, even beyond the nuclear family, with some families using it to barter for food or other supplies. The term 'liquid gold' holds very true here.
Iraq's relationship with breastfeeding is complex. While the government has worked hard to encourage breastfeeding, the country's history, marked by periods of war and intense conflict, have caused breastfeeding rates to remain relatively low. More than two decades ago the country began distributing free infant formula through Iraq's food rations. However, as with other war-torn nations, some areas in Iraq have experienced unsafe drinking water, leaving mothers with no options.
That said, Islam is the official state religion of Iraq, and there are strong feelings regarding breastfeeding. The majority of Muslims have very particular views about breastfeeding. The religious laws regarding breastfeeding are from the Qur'an, which states that all infants have the right to be breastfed and commands that mothers breastfeed until their child reaches approximately two years old. However, if both parents agree, the mother may wean earlier than two years or seek a wet-nurse. Interestingly, where womens' rights are often compromised, the right of a child to be nursed is extended more than in other countries, and even considered a 'right' where in other countries it is not.
Islamic law has particular views on the practice of wet-nursing. As breastfeeding is viewed as vital to a baby's well-being, women other than the child's mother may breastfeed a child. If a woman nurses a baby other than her own on more than five instances before the child's second birthday, she is considered a milk-mother, or rida'a. The breastfed child becomes a "milk-sibling" to the woman's biological children and thus is prohibited from marrying of them.
Iraq Photo Credit: Unicef Iraq
The strong endorsement of breastmilk has caused Brazil's infant mortality rate to nosedive more than two-thirds in the past two decades, largely in part to the public awareness campaigns supporting breastfeeding. More than half of Brazilian mothers breastfeed their infants until they are at least six months old.
The Brazilian government has gone to great lengths to support breastfeeding. In 1981, Brazil created the National Breastfeeding Program (PNBF), which aimed to regulate the advertising of formula, as well as support working mothers. In 2015, Brazil placed a ban on infant formula advertising. Additionally, there are significant fines for businesses who discriminate against breastfeeding women.
Perhaps the biggest breastfeeding success story from Brazil, however, is the creation of their maternal milk banks. The Brazilian Network of Human Milk Banks is the largest in the world. Of the close to 300 human milk banks in the world, Brazil has 220 of them. In 2014, close to 167,000 Brazilian women donated to milk banks and that number continues to grow as mothers want to return to more natural ways of childbearing and raising.
Brazil Photo Credit: Unicef Brazil
9. Republic of the Congo
The central-African nation of the Republic of Congo is home to the Aka, a nomadic pygmy tribe with a total population of 20,000 people. The Aka tribe values gender equality, with fathers spending as much time with their children as mothers. Upon living alongside the tribe, anthropology professor Barry Hewlett reports that male and female roles in the Aka tribe are entirely interchangeable.
As children are the center of the Aka tribe, they are with one of their parents at all times. In fact, they are held and do not touch the ground for the first year of life. They are equally close to both parents, with the Aka fathers maintaining a level of physical intimacy that would be foreign to many cultures throughout the world.
While living among the tribe, Professor Hewlett observed the Aka males breastfeeding their babies as a means of comfort. Though the ability to lactate is not present, the fathers willingly soothe their infants through the use of their nipple. It's not uncommon to find babies suckling their fathers breast.
Republic of the Congo Photo Credit: Trevor Davies
Breastfeeding is a way of life for women in Norway. Only 1% of Norwegian babies have never had breastmilk. Perhaps one of the reasons for breastfeeding success in Norway is the generous family leave policy. In Norway, parents are entitled to 46 weeks of leave at their full salary or 56 weeks at 80% of their salary. The ability to take an ample amount of time off from work after having a child supports breastfeeding.
Norway is the home to several milk banks and stands out for choosing not to pasteurize breast milk. Because so many mothers choose to breastfeed, the demand for donor milk remains relatively low, allowing for stricter screening mechanisms. Further, unlike many countries where donating breastmilk is cost-prohibitive, Norway compensates their mothers well for donating breastmilk.
As with many large and diverse countries, India has a broad range of breastfeeding practices. As a general rule, breastfeeding rates in India relatively low. Early initiation of breastfeeding is less than 50%, although exclusive breastfeeding at six months is 55%, higher than the United States.
India has a long way to go when it comes to breastfeeding acceptance, however. An Indian magazine recently drew considerable attention when a woman graced the cover breastfeeding a baby. Many people were outraged, despite the tasteful photo aimed at normalizing breastfeeding.
However, there are plenty of breastfeeding supporters in India, including the Bishnoi. The Bishnoi are a religious group of people that live in the Western Thar Dessert and the northern states of India. The Bishnois practice compassion for all living things, or "praan daya." As such, lactating women have been known to breastfeed deer. Injured or orphaned fawns are sometimes nursed back to health by this compassion tribe of women who view it as their responsibility to care for all living creatures
The history of breastfeeding in Japan mirrors many developed countries. As hospitalized births increased, breastfeeding rates decreased. While public awareness campaigns have helped to raise breastfeeding rates, many Japanese women still supplement with formula.
According to one mom blogger who lived in Japan, while breastfeeding is generally valued in the country, there is much less support for pumping breast milk. Many companies do not make accommodations for mothers to pump at work. Further, requesting that a baby's daycare provide breast milk is extremely challenging, with many regulations to follow. As a result, some working moms switch to formula.
Several ancient Japanese breastfeeding traditions remain in place today, such as the breast massage. Japanese midwife Sotomi Oketani formalized a breast massage technique aimed at stimulating milk production and removing clogged ducts. The Oketani method even helps mothers to cope with overproduction of milk. With close to 300 Oketani-trained midwives practicing in Japan today, breast massage is a common practice.
Oketani is also credited for helping countless mothers wean their child from the breast. While some Japanese women put wasabi or togarashi on their nipples to end the breastfeeding relationship, Oketani advises mothers to paint or draw bright faces on each of her breasts to discourage a child from wanting the breast. In her book, she explains that the painted faces, "makes kids feel a bit scared and at the same time impresses on them a mysterious feeling, like watching a drama."
Whether or not many mothers continue to follow Oketani's weaning suggestions is not entirely known. However, some moms share variations of this technique. One mom explained a commonly used, gentler, approach of covering the nipple with a Band-Aid and drawing an animal, such as a bunny or cat on the breast. The mother then tells her child that the milk is no longer there, and that is has been replaced by an animal.
Located in Central America, Guatemala suffers from very high infant and maternal mortality rates. Malnutrition plagues many Guatemalan people and limited access to quality healthcare adds to the challenges. In fact, nearly 80% of indigenous children in Guatemala suffer from malnutrition.
There are vast discrepancies in the breastfeeding values throughout Guatemala. A general lack of education leads to many misconceptions surrounding breastfeeding. For example, many women discard their colostrum, believing it to be "old milk" that is dirty, too cold, too thick and yellow, and unsafe to drink. When questioned about the practice, the Guatemalan women said that it had been done that way for years. Instead, many indigenous Guatemalan women give their newborns other liquids such as sugar water, soda, and even coffee, while waiting for their milk to come in.
However, those women who do go on to breastfeed, often do so for more extended periods of time. Due to food scarcity, many indigenous women wait to introduce solid foods to their babies until they are between 8 and 12 months old. Additionally, often due to financial resources, many of these women continue breastfeeding well into the toddler years.
Pakistan has struggled to increase their breastfeeding rates for years. As it currently stands, only 38 percent of children under the age of 6 months are breastfed by their mothers. More, exclusive breastfeeding rates are lower among more educated, wealthier women. With more access to formula, working women and those from the upper socio-economic strata tend to bottle feed at higher frequencies.
As Pakistan is a very patriarchal society, males have a greater advantage when it comes to breastfeeding. Mothers in Pakistan breastfeed their daughters for significantly less time than they do their sons, and this is especially so if they do not have elder sons. Many women terminate their breastfeeding relationship with their daughters in the hopes of becoming pregnant again, this time with a son.
Finally, breastfeeding in public is unheard of in Pakistan. Considered a very private act, most women find discrete places to breastfeed. A chaddar or a dupatta cover those brave few who do breastfeed in public. According to columnist Mehr Tarar, "No woman, even those who wear miniskirts, breastfeed in public."
In 2014, the United Arab Emirates (UAE), the Arabian Peninsula nation that borders the Persian Gulf, passed a law that requires mothers to breastfeed their children until they are two years old. Despite push-back that the law might penalize mothers who have difficulty breastfeeding or allow for husbands to sue their wives for not nursing their babies, the law remained in place. The UAE's federal national council agreed to provide wet nurses for children whose mothers had died or are unable to feed them.
By all accounts, it has been impossible to enforce the law. "The law is extremely hard to police as currently there is zero data collection in the UAE on breastfeeding rates on children after six months," says midwife Shani Dean. "As it stands the law is unclear about the status of the amount of breastfeeding it requires, as by this stage children are supplemented with solid foods, and other forms of milk and water."